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Gonococcal Arthritis — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesGonococcal ArthritisRACP Adult Medicine

A 22-year-old sexually active man presents with an acutely hot swollen right knee, fever (38.5°C), and a vesiculopustular rash on his hands and feet. He has migratory polyarthralgia preceding the knee monoarthritis. Urethral swab PCR is positive for Neisseria gonorrhoeae. What is the most likely diagnosis?

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Correct answer: E — Septic arthritis

Acute monoarthritis with fever, vesiculopustular rash (on hands/feet), migratory polyarthralgia, and positive gonococcal urethral swab is disseminated gonococcal infection (DGI) with gonococcal septic arthritis. DGI has two presentations: the arthritis-dermatitis syndrome (migratory polyarthralgia, rash, tenosynovitis) and purulent monoarthritis. Treatment: IV ceftriaxone. Joint washout if purulent. Treat concurrent chlamydial co-infection.

Reference: eTG Antibiotic – 2025 – Gonococcal Arthritis; ASHM/STIGMA 2024